Page 178 - 2022 Ranger Medic Handbook

METRONIDAZOLE (FLAGYL, METROGEL)
Class: Antimicrobial – antibiotic, antitrichomonal, amebicide
Action: Synthetic compound with direct trichomonacidal, amebicidal, and antibacterial activity (anaerobic bacteria
and some gram-negative bacteria); effective against Trichomonas vaginalis, Entamoeba histolytica, Giardia lamblia,
obligate anaerobic bacteria, gram-negative anaerobic bacilli, and Clostridia; microaerophilic streptococci and most
aerobic bacteria are resistant
Dose: For giardia 250mg PO tid × 5–7 days; for amebiasis (dysentery) 500–750mg PO tid × 7–10 days; for pseudo-
membranous colitis, 250–500mg PO tid–qid; for trichomoniasis, 2g PO once or 500mg PO bid × 7 days; for bite wound
(animal/human) 500mg q8hr × 3–5 days; for bacterial vaginosis 500mg PO bid for 7 days
Indications: For giardiasis, trichomoniasis, amebiasis, and amebic liver abscess; topical for rosacea
Contraindications: Blood dyscrasias; active CNS disease; pregnancy category may use during pregnancy and cau-
tion advised while breastfeeding
Adverse/Side-effects: Hypersensitivity (rash, urticaria, pruritus, flushing), fever, fleeting joint pains, Candida over-
growth; vertigo, headache, ataxia, confusion, irritability, depression, restlessness, weakness, fatigue, drowsiness,
insomnia, paresthesia, sensory neuropathy; nausea, vomiting, anorexia, epigastric distress, abdominal cramps, diar-
SECTION 4 creased libido, nasal congestion; ECG changes (flattening of T wave)
rhea, constipation, dry mouth, metallic or bitter taste, proctitis; polyuria, dysuria, pyuria, incontinence, cystitis, de-
Interactions: Oral anticoagulants potentiate hypoprothrombinemia; alcohol and solutions of citalopram, ritonavir,
lopinavir, and IV formulations of sulfamethoxazole, trimethoprim, nitroglycerin may elicit disulfiram reaction due to the
alcohol content; disulfiram causes acute psychosis; phenobarbital increases metabolism; may increase lithium levels;
fluorouracil, azathioprine may cause transient neutropenia
Mission Impact: GROUNDING medication for personnel on flight status.

MIDAZOLAM (VERSED) * – CONTROLLED SUBSTANCE II
Class: CNS agent – Benzodiazepine
Action: Binds to specific sites on GABA type A receptors within the brain.
Dose: 0.07–0.08mg/kg IM (average or typical adult dose is 5mg IM).10mg IM for seizure control. 2–5mg IV/IO slowly
q2–3min to maximum adult dose of 10mg. Titrate to achieve necessary level. (The patient is somewhat somnolent,
but still easily arousable.)
Onset/Peak/Duration:
IV – Onset in 1–5 minutes/Peak rapid/Duration 2–6 hours
IM – Onset in 5–15 minutes/Peak in 15–60 minutes/Duration 2–6 hours
Indications: Sedation in combination with analgesia to perform brief, but painful procedures, treatment of active
seizures, sedation of agitated patients
Contraindications: Known sensitivity to benzodiazepines, acute narrow angle glaucoma, injectable midazolam
should not be administered to adult or pediatric patients in shock or coma, or in acute alcohol intoxication with
depression of vital signs, pregnancy category consider alternative during pregnancy and may use short-term while
breastfeeding
Adverse/Side-effects: Laryngospasm, bronchospasm, wheezing, shallow respirations, bradycardia, tachycardia,
vomiting, retrograde amnesia, hallucination, confusion, blurred vision, diplopia, nystagmus, pinpoint pupils, anaphy-
lactoid reactions, hives, rash, pruritus, yawning, lethargy, chills, weakness
Interactions: Use with caution when other medications capable of producing central nervous system depression
are used
Mission Impact: GROUNDING medication for personnel on flight status
K9 Dosage: For sedation combined with opioid, 7.5mg (0.25mg/kg) IV/IM q4hr
Notes: Monitor patients continuously for early signs of hypoventilation, airway obstruction, or apnea. Use with caution
in patients with severe fluid or electrolyte disturbances.

164 SECTION 4 RANGER MEDIC PHARMACOLOGY & FORMULARY